Expert Neurologist Explains the Rise of Parkinson’s Disease: 6 Key Questions Answered

Parkinson’s disease is the fastest growing brain disease in the world. How did that happen? Six questions to neurologist Femke Dijkstra.

In Belgium, the number of patients is estimated at 40,000 and that number is expected to triple by 2040. Scientists are still not quite sure what exactly causes this complex motor disorder. There are, however, some noteworthy findings.

Why is the number of patients with Parkinson’s disease rising so fast?

Femke Dijkstra (neurologist, UZA): The most obvious reason is that there are more patients due to the aging population. At the same time, we can keep the disease under better control, so that people live longer and therefore stay longer in the statistics.

However, there are also a number of environmental factors contributing to the increase. A striking possible cause is the reduced smoking behavior in the general population. Epidemiological studies have shown that people who smoke develop Parkinson’s much less often than non-smokers. In Parkinson’s disease, dopamine-producing neurons are broken down and nicotine is said to counteract that process. Obviously, it is not the intention to regard smoking as a form of prevention for Parkinson’s disease. After all, smoking greatly increases the risk of lung cancer and cardiovascular disease.

In recent years, there have also been an increasing number of patients in fast-developing China. Do factors of civilization such as pollution and ultra-processed food play a role?

Dijkstra: Environmental factors such as air pollution and unhealthy diet are indeed increasingly in the spotlight as possible causes. Parkinson’s disease is more than just a brain disease. It is possible that cells from the peripheral nervous system, that the respiration and digestion are involved. Hence, air pollution and the microbiome (the bacteria, viruses and yeasts in the intestines, ed), are currently receiving increased attention.

What has now been clearly demonstrated is the use of pesticides in agriculture as a risk factor for Parkinson’s disease. The disease is significantly more common in farmers and their environment. Pesticides on agricultural products find their way to our plates, but it is not clear whether consumers also run a greater risk of contracting Parkinson’s disease. In any case, there is no hard evidence for this. But it would not be a bad thing if the government paid more attention to reducing exposure to toxic substances and pesticides.

Between 5 and 10 percent of PwPs are younger than 50 years. That number is also steadily increasing. How did that happen?

Dijkstra: The fact that there are more young patients shows that Parkinson’s is not just a disease of old age, but that there is more to it. In addition, more and more attention is being paid to the diagnosis in younger people. Those who used to go to the doctor with unexplained shoulder pain may have been diagnosed with ‘frozen shoulder’, while Parkinson’s is now also taken into account. The symptoms in younger people are different from those in the elderly. The latter mainly concerns falls and memory problems. The symptoms in younger patients are trembling, cramps, tingling, but also depression, reduced motivation, reduced sense of smell or sleep disturbances.

Is the doctor solely dependent on the patient’s story in the diagnosis?

Dijkstra: When diagnosing, the neurologist looks at the external symptoms. To speak of parkinson, the following factors must be present: slowness of movement with stiffness and/or trembling. Medical imaging of the brain can support that diagnosis by ruling out other diseases, but it is not necessarily necessary. A brain scan may show a loss of dopamine-producing cells, but that does not necessarily mean that you have Parkinson’s disease. For this, two of the three movement symptoms must also be met.

Can the disease be treated properly?

Dijkstra: For now, there are no therapies to cure the disease. We can sufficiently control symptoms such as trembling with medication, but it must be taken continuously. Sometimes more invasive treatments are warranted, such as deep brain stimulation. This involves implanting electrodes in the brain so that the patient regains control over his movements. There are good prospects for scientific research into new drugs, but they are still in the clinical trial phase. These are treatments that counteract protein accumulation in the brain, act on the genes that cause Parkinson’s or act on the proteins that damage brain cells.

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